The 2006 NIH State-of-the-Science Conference Statement on Tobacco Use: Prevention, Cessation, and Control emphasized the need to "tailor interventions for different populations because generic treatments may not be appropriate for everyone," and to determine the effectiveness of cessation activities in populations with high rates of tobacco use and other comorbidities. They identified the HIV-infected community as a high priority target for these efforts. More than half of persons with HIV (PWHs) in the US smoke cigarettes, and incidence rates of cardiac events and tobacco related cancers are rising in this group at an alarming rate. The psychosocial profile of the HIV-infected community, characterized by high rates of psychiatric comorbidity, drug and alcohol use, and low levels of social support, suggests that achieving high cessation rates will be a great challenge. The main goals of this proposal are to (1) develop and pilot a tailored, multicomponent, intensive smoking cessation intervention for PWHs based upon a body of behavioral data that the investigators have collected in a preliminary study, and (2) perform a randomized, controlled study in PWH smokers to determine the efficacy of the tailored intervention in achieving three month, point-prevalence abstinence from tobacco use. The long term objectives of the proposed study are to expand the available knowledge base on smoking cessation in PWHs, and to develop an intensive smoking cessation program curriculum appropriate for PWHs throughout the nation. PUBLIC HEALTH RELEVANCE: The epidemic of cigarette smoking superimposed upon an aging population of persons living with HIV (PWHs) and its associated comorbidities represents an emerging public health crisis. PWH smokers have few, if any, smoking cessation resources available to them that are tailored to their needs, and their care providers have virtually no studies upon which to build an evidence-based approach to achieving abstinence. This proposal, if funded, will begin to address these critical needs.